Barreto Daniela Veit, Barreto Fellype de Carvalho, de Carvalho Aluízio Barbosa, Cuppari Lilian, Draibe Sérgio Antonio, Dalboni Maria Aparecida, Moyses Rosa Maria Affonso, Neves Kátia Rodrigues, Jorgetti Vanda, Miname Marcio, Santos Raul D, Canziani Maria Eugênia Fernandes
Division of Nephrology, Department of Internal Medicine, Federal University of São Paulo, São Paulo, Brazil.
Nephron Clin Pract. 2008;110(4):c273-83. doi: 10.1159/000170783. Epub 2008 Nov 12.
Calcium-containing phosphate binders have been shown to increase the progression of vascular calcification in hemodialysis patients. This is a prospective study that compares the effects of calcium acetate and sevelamer on coronary calcification (CAC) and bone histology.
101 hemodialysis patients were randomized for each phosphate binder and submitted to multislice coronary tomographies and bone biopsies at entry and 12 months.
The 71 patients who concluded the study had similar baseline characteristics. On follow-up, the sevelamer group had higher levels of intact parathyroid hormone (498 +/- 352 vs. 326 +/- 236 pg/ml, p = 0.017), bone alkaline phosphatase (38 +/- 24 vs. 28 +/- 15 U/l, p = 0.03) and deoxypyridinoline (135 +/- 107 vs. 89 +/- 71 nmol/l, p = 0.03) and lower LDL cholesterol (74 +/- 21 vs. 91 +/- 28 mg/dl, p = 0.015). Phosphorus (5.8 +/- 1.0 vs. 6 +/- 1.0 mg/dl, p = 0.47) and calcium (1.27 +/- 0.07 vs. 1.23 +/- 0.08 mmol/l, p = 0.68) levels did not differ between groups. CAC progression (35 vs. 24%, p = 0.94) and bone histological diagnosis at baseline and 12 months were similar in both groups. Patients of the sevelamer group with a high turnover at baseline had an increase in bone resorption (eroded surface, ES/BS = 9.0 +/- 5.9 vs. 13.1 +/- 9.5%, p = 0.05), whereas patients of both groups with low turnover at baseline had an improvement in bone formation rate (BFR/BS = 0.015 +/- 0.016 vs. 0.062 +/- 0.078, p = 0.003 for calcium and 0.017 +/- 0.016 vs. 0.071 +/- 0.084 microm(3)/microm(2)/day, p = 0.010 for sevelamer).
There was no difference in CAC progression or changes in bone remodeling between the calcium and the sevelamer groups.
含钙的磷结合剂已被证明会增加血液透析患者血管钙化的进展。这是一项前瞻性研究，比较了醋酸钙和司维拉姆对冠状动脉钙化（CAC）和骨组织学的影响。
101例血液透析患者被随机分配接受每种磷结合剂治疗，并在入组时和12个月时接受多层冠状动脉断层扫描和骨活检。
完成研究的71例患者具有相似的基线特征。随访时，司维拉姆组的完整甲状旁腺激素水平较高（498±352 vs. 326±236 pg/ml，p = 0.017）、骨碱性磷酸酶水平较高（38±24 vs. 28±15 U/l，p = 0.03）、脱氧吡啶啉水平较高（135±107 vs. 89±71 nmol/l，p = 0.03），而低密度脂蛋白胆固醇水平较低（74±21 vs. 91±28 mg/dl，p = 0.015）。两组之间的磷（5.8±1.0 vs. 6±1.0 mg/dl，p = 0.47）和钙（1.27±0.07 vs. 1.23±0.08 mmol/l，p = 0.68）水平无差异。两组的CAC进展（35% vs. 24%，p = 0.94）以及基线和12个月时的骨组织学诊断相似。基线时骨转换率高的司维拉姆组患者骨吸收增加（侵蚀表面，ES/BS = 9.0±5.9 vs. 13.1±9.5%，p = 0.05），而基线时骨转换率低的两组患者骨形成率均有所改善（BFR/BS = 0.015±0.016 vs. 0.062±0.078，醋酸钙组p = 0.003；司维拉姆组为0.017±0.016 vs. 0.071±0.084 μm³/μm²/天，p = 0.010）。
钙组和司维拉姆组在CAC进展或骨重塑变化方面无差异。
